Schedule an Appointment

 
 
Name *
Name
Phone *
Phone
Our machine services the following options.
Brain Aneurysm Clips *
Please indicate if you have this implanted device.
Cardiac Pacemaker *
Please indicate if you have this implanted device.
Any magnetically-activated device *
Cardiac Defibrillator *
Please indicate if you have this implanted device.
Any electronic device *
Please indicate if you have any electronic devices.
Have you ever had surgery to replace or implant anything in your body? *
(Heart, eyes, ears, joints, reproductive organs, or any other body part, etc.)
Have you ever been injured by a metallic object or foreign body? (BB, shrapnel, bullet, fragment in the eye from welding, etc.) *
Date of Birth
Date of Birth